Diabetes and work force productivity: An assessment of diabetes-related productivity losses among type II diabetes patients in central Texas

Study Objective: This study estimates: 1) the productivity-related costs associated with employee absence on the job due to a diabetes-related hospitalization, 2)the productivity losses associated with diabetes-related disability, and 3) the productivity losses associated with employee presence on the job (reduced productivity while on the job and/or reduced time at work due to diabetes-related ambulatory care visits). We model total productivity loss (sum of 1,2,3) as a function of identified demographic and clinical characteristics.

Methods: Data were obtained from electronic medical records (EMR) and survey responses of 376 adults aged 18 or older who consented to participate in a randomized trial of Type 2 diabetes self-management programs in Central Texas. All study participants had uncontrolled diabetes and were randomized into one of four study arms: personal digital assistant diabetes software(PDA), Chronic Disease Self-Management Program(CDSMP), combined PDA and CDSMP (COM), and controls. The study lasted two years. EMR were used to estimate 1) employee absence on the job due to a diabetes-related hospitalization using length of stay over a one-year period. A multiplication factor from the literature was used to estimate 2) employee absence on the job due to diabetes-related disability. 3) Reduced productivity and time on the job are estimated using survey responses on impairments that limit work and EMR on the number of diabetes-related ambulatory care visits. The human-capital approach to estimate lost productivity is used to cost components 1, 2 and 3, which are summed to obtain total productivity loss. Using robust regression, we model total productivity loss as a function of different diabetes self-management programs, as well as other identified demographic and clinical characteristics.

Results:Compared to the controls, there were no statistically significant differences in productivity losses among persons undergoing any of the three diabetes-management interventions. Males were associated with higher productivity losses (+$708/year;p<0.001). Persons with greater than high school education were also associated with additional productivity losses (+$758/year;p<0.001). Persons with more than 1 comorbid condition were marginally associated with lesser productivity losses (-$326/year; p=0.055). Compared to non-Hispanic whites, there were no statistically significant differences among persons of Hispanic or African-American descent. Neither higher baseline HbA1c values nor longer diabetes duration were significantly associated with productivity losses.

Conclusions: We are unable to find evidence the chronic disease management programs examined in this trial control indirect productivity losses. Persons with chronic conditions such as diabetes may continue to work despite their illnesses, until they are unable to work.